1. Returning Veterans with Health Concerns and Emerging Problems: How can they get help? William M. Keyes, QMC (SW) U.S. Navy (Retired) Program Support Specialist/Outreach Coordinator War Related Illness & Injury Study Center (WRIISC) NJ VA Healthcare System

2. The War Related Illness and Injury Study Center (WRIISC, pronounced “risk”) is a National Department of Veterans Affairs (VA) program established to develop and provide expertise in post-deployment health for Veterans and healthcare providers. We recognize that deployed Veterans have unique healthcare problems. We strive to improve the health of Veterans with war related illnesses and injuries. Three National Locations: East Orange, New Jersey Washington, DC Palo Alto, California

3. What is the WRIISC?  We provide specialized clinical and referral services to Veterans and their health care providers for a wide variety of post deployment health concerns.  Each WRIISC has a multidisciplinary team of health care professionals who are experts in responding to a wide variety of post-deployment health concerns.  These include exposure related concerns and symptoms and syndromes that do not have a clear medical explanations.

4. What is the WRIISC (continued)  Medical doctors  Physician assistants  Nurses  Nurse practitioners  Specialists in environmental exposure assessments  Psychologists  Neuropsychologists  Social workers  Chaplains  Risk communication specialists  Health education specialists  Health care professionals that specialize in Complementary and Alternative Medicine (CAM) such as:  Acupuncturists  Yoga instructors The WRIISC has access to a wide variety of medical professionals including:

5. Goals  Provide clinical services to Veterans with deployment-related health concerns and illnesses to improve their health-related quality of life  Advance knowledge of ways to care for Veterans with medically unexplained symptoms to improve their health-related quality of life  Advance knowledge of and improve communication among Veterans, the health care community and researchers regarding deployment-related health concerns and illnesses  Advance knowledge of medically unexplained symptoms in Veteran and other populations

6. WRIISC Components  Clinical  Education  Risk Communication  Research

7. Our Clinical Services  Comprehensive medical evaluations of medically unexplained symptoms for Veterans from any era or conflict  Comprehensive medical evaluations of OEF/OIF Veterans with health concerns related to deployment

8. Clinical Services cont…  Comprehensive reviews of military exposures from Veterans form any era or conflict  Screening evaluation for mild traumatic brain injury in combat Veterans  Provide Support/Re-integration groups for Veterans experiencing difficulty adjusting

9. OEF/OIF Evaluations  1 day evaluation to address deployment related concerns  Practice primary prevention  Ensure primary care provider has been assigned  Get Veteran smoothly transitioned into the VA system

10. Comprehensive Evaluations of Medically Unexplained Symptoms  2 day evaluation  Veterans of any conflict  Must be referred by their VA primary care provider  Focus on MUS (CFS, FM, IBS) and symptom management

11. Clinical Evaluation Components  History and Physical  Psychological Evaluation  Neuropsychological Evaluation  Exposure Assessment  Social Work Interview  Education Session  Complementary and Alternative (CAM)  Labs, X-ray's, EKGs, PFTs

12. Clinical Evaluation Components  Final meeting with the Veteran and the team to discuss the findings and recommendations  Veteran is provided with a treatment “roadmap”

13. Clinical Evaluation- Follow up  Follow up by social work at 1mo, 6 mo and 1 year post evaluation  Follow-up health survey: 6 mo post eval  How satisfied?  Barriers to recommendation implementation?  Symptom management?

14. Summary 1.The WRIISC was established to be a VA National Resource with staff that are experts in post-deployment health. 2.We provide comprehensive clinical evaluations on Veterans that have returned from combat. a)These examinations allow us to help the individual Veteran and their providers to better address the Veteran’s post-deployment health issues. b)These evaluations also enable us to identify emerging post- deployment health problems and concerns that may effect large numbers of Veterans Nationally. c)We also educate the VA and non-VA provider community about post-deployment health problems and concerns.

15. Summary (cont.) 3.We focus on prevention – through post deployment care, research, education and communication. 4.We specialize in providing Veterans a roadmap for managing their chronic symptoms

16. Questions??